Provider Demographics
NPI:1235404062
Name:ROCKY MOUNTAIN TREATMENT SERVICES LLC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN TREATMENT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:D
Authorized Official - Last Name:DENZEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:970-351-2412
Mailing Address - Street 1:2928 W 10TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-5426
Mailing Address - Country:US
Mailing Address - Phone:970-351-2412
Mailing Address - Fax:970-351-2427
Practice Address - Street 1:2928 W 10TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-5426
Practice Address - Country:US
Practice Address - Phone:970-351-2412
Practice Address - Fax:970-351-2427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32068207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01320688Medicaid
CO01320688Medicaid
COC498038Medicare PIN